Measuring and understanding social-emotional behaviors in preschoolers from rural Pakistan

Effectiveness of Learning through Play Plus (LTP Plus) Parenting Intervention on Behaviours of Young Children of Depressed Mothers: A Randomised Controlled Trial

Evidence has shown that parenting intervention programmes improve parental knowledge, attitudes, and practices, which helps in promoting child development. This study aims to examine the effectiveness of parenting intervention in improving child behaviours. This is a secondary analysis of data from a cluster-randomised controlled trial with depressed mothers aged 18-44 years with a child aged 0 to 36 months. This paper reports findings from the dataset of participants with a child aged between 24 and 36 months. Villages (n = 120) were randomised into either of two arms: learning through play plus (LTP Plus) or treatment as usual (TAU). LTP Plus is a 10-session, group parenting intervention integrated with cognitive behaviour therapy, delivered over 3 months. This secondary analysis reports findings on the Eyberg Child Behaviour Inventory (ECBI) and the Home Observation for Measurement of the Environment (HOME). Findings show a significant improvement in child behaviour (ECBI) scores (p < 0.011) and HOME scores (p < 0.001) in the intervention group compared to TAU at 3-month follow-up. In a low-resource setting, low-cost group parenting intervention delivered by community health workers has the potential to improve child behaviours and quality of the home environment. Parenting interventions aimed at improving child behavioural problems can have significant implications for the child, family, and broader societal outcomes. Addressing behavioural problems in early years, parenting interventions can potentially reduce long-term consequences and costs associated with untreated child behavioural issues.

Non-linear associations between HPA axis activity during infancy and mental health difficulties during early childhood among children in rural Pakistan

Hypothalamic pituitary adrenal (HPA) axis activity may be a mechanism linking early adversity to child mental health difficulties. However, there is a dearth of longitudinal evidence for the association between HPA axis activity and mental health among children in low-resource contexts. The goal of this study is to examine linear and curvilinear associations between HPA axis activity during infancy and mental health difficulties in early childhood among children in rural Pakistan. Participants included 104 children (46% male) from the Bachpan study, a longitudinal cohort embedded within a maternal depression trial in Pakistan. We examined the associations between hair-derived cortisol and dehydroepiandosterone (DHEA) at 12 months old and mental health difficulties, measured with the Strengths and Difficulties Questionnaire (SDQ), at 36 months old. There was a significant quadratic association between hair cortisol and SDQ scores, with results showing a U-shaped relationship (i.e., having relatively high or low cortisol predicted increased mental health difficulties). DHEA showed a quadratic association with SDQ scores with an inverted U-shaped relationship (i.e., high and low DHEA was associated with decreased mental health difficulties). Results provide evidence of longitudinal and curvilinear effects of cortisol and DHEA during infancy on mental health difficulties in early childhood.

Association of household food insecurity with developmental delay in preschool children: 2018 Ecuadorian Nutrition and Health National Survey

We investigated the association of household food insecurity (HFI) with developmental delays in 36-59-month-old preschool children (n 7005) using cross-sectional data from the 2018 Ecuadorian National Health and Nutrition Survey. HFI was assessed with the Food Insecurity Experience Scale and developmental delays with the Early Childhood Development Index. Log-binomial regression models estimated the association of HFI with global (overall) developmental delay (GDD) and delays in four individual developmental domains, adjusting for covariates. Nearly half of the children lived in households with marginal (24⋅5 %) or moderate-severe HFI (21⋅7 %). Eighteen percent were identified with GDD. Delays in the individual domains of literacy-numeracy, social-emotional, physical and cognitive development were identified for 64, 21⋅5, 3⋅3 and 3⋅1 %, respectively. GDD was more likely among preschool children from households with marginal (aPR = 1⋅29; 95 % C.I. = 1⋅10, 1⋅49) and moderate-severe HFI (aPR = 1⋅30; 95 % C.I. = 1⋅11, 1⋅51). Social-emotional development delays were also more likely among those from households with marginal (aPR = 1⋅36; 95 % C.I. = 1⋅19, 1⋅56) and moderate-severe HFI (aPR = 1⋅33; 95 % C.I. = 1⋅15, 1⋅54) different from the other three domains. Several other potentially modifiable risk (violent discipline, maternal depressive symptoms) and protective factors (adequate child stimulation, higher maternal education, handwashing with soap/detergent) were also independently associated with GDD and/or literacy-numeracy and cognitive delays. Our findings suggest that HFI is an independent risk factor for GDD and social-emotional developmental delays in Ecuadorian preschoolers. They underscore the importance of strengthening and expanding poverty reduction, food security and early childhood development policies and interventions to improve the opportunities for children to achieve their full developmental potential.

Association between Mothers' Emotional Problems and Autistic Children's Behavioral Problems: The Moderating Effect of Parenting Style

Mothers' emotional problems are associated with autistic children's behavioral problems. We aim to test whether parenting styles moderate associations between mothers' mood symptoms and autistic children's behavioral problems. A sample of 80 mother-autistic child dyads were enrolled at three rehabilitation facilities in Guangzhou, China. The Social Communication Questionnaire (SCQ) and the Strengths and Difficulties Questionnaire (SDQ) were used to collect the autistic symptoms and behavioral problems of the children. Mothers' depression and anxiety symptoms were measured using the Patient Health Questionnaire 9 (PHQ-9) and the General Anxiety Disorder 7-item (GAD-7) scale, respectively, and parenting styles were measured using the Parental Behavior Inventory (PBI). Our results show that mothers' anxiety symptoms were negatively associated with their children's prosocial behavior scores (β = -0.26, p < 0.05) but positively related to their social interaction scores (β = 0.31, p < 0.05). Supportive/engaged parenting styles positively moderated the effects of mothers' anxiety symptoms on their prosocial behavior score (β = 0.23, p = 0.026), whereas hostile/coercive parenting styles had a negative moderation (β = -0.23, p = 0.03). Moreover, hostile/coercive parenting styles positivity moderated the effects of mothers' anxiety symptoms on social interaction problems (β= 0.24, p < 0.05). The findings highlight, where mothers adopted a hostile/coercive parenting style while experiencing high anxiety, their autistic child may have more serious behavioral problems.

How the home learning environment contributes to children's social-emotional competence: A moderated mediation model

Introduction

The home learning environment is the earliest contact learning environment in early childhood development, which plays an important role in the development of children's social-emotional competence. However, previous studies have not clarified the precise mechanisms by which the home learning environment influences children's social-emotional competence. Therefore, the purpose of the study is to explore the relationship between the home learning environment and its intrinsic structure (i.e. structural family characteristics, parental beliefs and interests, and the educational processes) and children's social-emotional competence, and whether gender plays a moderating role in the relationship.

Method

The study randomly selected a sample of 443 children from 14 kindergartens in western China. The Home Learning Environment Questionnaire and the Chinese Inventory of Children's Social-emotional competence scale were used to investigate the home learning environment and social-emotional competence of these children.

Results

(1) Structural family characteristics and parental beliefs and interests both had a significant positive predictive effect on children's social-emotional competence. (2) The educational processes fully mediate between structural family characteristics, parental beliefs and interests, and children's social-emotional competence. (3) Gender moderated the effect of the home learning environment on children's social-emotional competence. Gender moderates not only the indirect effects between parental beliefs and interests and children's social-emotional competence, but also the indirect effects between structural family characteristics and children's social-emotional competence. At the same time, gender also moderated the direct effects between parental beliefs and interests and children's social-emotional competence.

Discussion

The results emphasize the crucial role of the home learning environment in the development of children's early social-emotional competence. Therefore, parents should pay attention to the home learning environment and improve their ability to create a home learning environment that promotes the positive development of children's social-emotional competence.

The unique relevance of executive functions and self-regulation behaviors for understanding early childhood experiences and preschoolers' outcomes in rural Pakistan

Performance-based measures of children's executive functions (EFs) do not capture children's application of these skills during everyday emotionally-laden and socially-mediated interactions. The current study demonstrates the value of using assessor report of self-regulation behaviors (inhibitory control and positive affect/engagement) in addition to EF tasks when studying early childhood experiences and development in a rural lower-middle-income country setting. In a sample of 1302 disadvantaged 4-year-olds living in rural Pakistan, we found that directly assessed EFs were significantly related to assessor observations of children's inhibitory control and positive affect/engagement during a structured assessment protocol. However, EFs and two types of self-regulation behaviors demonstrated unique associations with children's (1) contextual experiences, as indexed by family socio-economic resources, participation in parenting interventions, and children's physical growth; and (2) age-salient developmental outcomes, as indexed by direct assessment of pre-academic skills and maternal report of prosocial behaviors and behavior problems. First, family wealth uniquely predicted only observed positive affect/engagement, whereas maternal education uniquely predicted only EFs. Second, children's antecedent linear growth was a significant predictor of both EFs and positive affect/engagement, but exposure to an enhanced nutrition intervention during the first 2 years of life and preschoolers' hair cortisol concentration were associated only with observed self-regulation behaviors. Finally, both EFs and observed positive affect/engagement uniquely predicted children's pre-academic skills. In contrast, only assessors' ratings of positive affect/engagement uniquely predicted maternal report of prosocial behaviors and only assessors' ratings of inhibitory control uniquely predicted maternal report of behavioral problems.

Prevalence and factors associated with behavioural problems in children with epilepsy attending Mulago hospital, Uganda: A cross-sectional study

PURPOSE

To determine the prevalence of behavioural problems and the associated factors in children with epilepsy (CWE).

METHODS

This was a cross-sectional study conducted at Mulago National Referral Hospital, Kampala, Uganda, from December 2019 to May 2020. A total of 300 CWE aged 6 to 17 years were consecutively enrolled and assessed for behavioural problems using the Strengths and Difficulties Questionnaire. We obtained data on the associated factors by using pretested structured questionnaires, the Rosenberg Self-Esteem Scale, the Kilifi Stigma Scale of Epilepsy, the Morisky medication adherence scale and the Tumaini Child Health Screener for childhood disabilities.  Simple logistic regression and multivariate analysis was done to determine the associated factors while adjusting for the presence of neurodevelopmental disorders and childhood disabilities.

RESULTS

Behavioural problems were detected in 108/300 CWE (36%) with more internalizing (28%) than externalizing (21%) behaviour scores noted. The odds of behavioural problems increased with the presence of co-morbid neurodevelopmental disorders or childhood disabilities (cOR: 5.42, p-value < 0.001). Factors associated with occurrence of behavioural problems were high stigma perception (aOR: 4.06, p-value < 0.001) and being seizure-free in the last six months (aOR: 3.43, p-value =0.031) while being an adolescent (aOR: 0.33, p=0.001) lessened the risk.

CONCLUSIONS

Behavioural problems occur in more than a third of CWE. They are more in the internalizing domain than in the externalizing domain. Their odds increase with high perceived stigma and in the first six months of seizure control.

Parental perception on screen time and psychological distress among young children

OBJECTIVE

We aimed to assess the parent-reported screen time of children, identify the perceived risk factors for increased screen time and its relationship to psychological distress in children.

MATERIALS AND METHOD

A cross sectional study was conducted at a teaching hospital in Karachi, Pakistan. A total of 230 employees from medical and non-medical departments were included. Participants were employees with child/children ages 4-12 year who consented to participate in the study, we included 135 fathers and 91 mothers. The questionnaire included (i) demographic data (ii) Media history exam form and (iii) parent reported strength and difficult questionnaire (SDQ).

RESULT

The average daily screen time reported was 2.5 (1.5-5) hour for boys and 2 (1-4) hour for girls. Preschoolers had greater screen time as compared to school-aged children (Median (IQR): 3 (1.5-5.6) vs 2 (1-4), P = 0.46). The children owned devices with approximately equal distribution of preschoolers and school-aged children (19 (27.1%) and 48 (30%), P = 0.661 respectively). Emotional score was found higher in school-aged group in comparison to preschoolers (p = 0.036). Moreover, mother screen time and number of devices owned by a child were found to be positively associated with child's screen time.

CONCLUSION

We conclude that as we are embracing the digital age providing a tech free zone to children is virtually impossible. Children screen time related activities in our part of the world exceeds the limitation. Parental awareness and co-viewing screen with their children are essential to avoid media related behavior problems.

Household food insecurity and early childhood development: Systematic review and meta-analysis

Household food insecurity (HFI) is a powerful stressor negatively associated with early childhood development (ECD). However, no comprehensive review has examined the association of HFI and ECD. Therefore, this systematic review and meta-analysis investigated the association between HFI and ECD domains and subdomains in children under 5 years old. Peer-reviewed and grey literature were systematically searched in electronic databases with no year or language restrictions. Studies were eligible if they assessed the association between HFI and one or more ECD domains. Data were extracted using a standard predefined protocol. Meta-analysis was performed, and the heterogeneity across studies was explored. Nineteen studies were included in the systematic review and 14 in the meta-analysis. Of the studies, 15 were from high income countries (HICs) and four from low-middle income countries (LMICs). For developmental risk and the cognitive/math and cognitive/school readiness and reading subdomains, the only studies available were conducted in HICs. The meta-analysis showed that HFI was associated with developmental risk (OR 1.28; 95% CI [1.14, 1.45]), cognitive/vocabulary (OR 0.94; 95% CI [0.90, 0.98]), and cognitive/math (OR 0.84; 95% CI [0.73, 0.96]). HFI was marginally associated with cognitive/school readiness and reading (OR 0.91; 95% CI [0.82, 1.00]) and motor development (OR; 0.91, 95% CI [0.80, 1.04]). HFI was associated with poor ECD in children under 5 years old. Specifically, HFI was associated with developmental risk and poor math skills in studies conducted in HICs and with poor vocabulary skills in studies conducted in both HICs and LMICs. Prospective studies examining HFI and ECD are needed in LMICs.

Measuring Young Children's Executive Function and Self-Regulation in Classrooms and Other Real-World Settings

A number of different approaches are currently used for assessing young children's executive function (EF) and self-regulation (SR) skills. Nevertheless, guidance for stakeholders aiming to assess EF and SR in real-world settings (e.g., preschool classrooms) is currently lacking. In the present article, I review the properties, strengths, and weaknesses of three common approaches to EF and SR measurement: direct assessments, adult reports, and observational tools. Building on this general review, I next highlight several considerations specific to EF and SR measurement of young children in everyday contexts. In particular, I consider the ecological validity, interpretability, and scalability of each approach to EF and SR measurement, concluding with future directions for research.